We congratulate Sidhu and Naugler1 on their article lending support to nonfasting lipid profiling. To inform the care of an individual patient, Sidhu and Naugler1 focus on the average population-level impact of nonfasting on lipid levels. However, to help bring their results closer to the bedside, patient-level considerations must be highlighted.
In primary care offices, low-density lipoprotein cholesterol (LDL-C) is the central focus on lipids, as recommended by worldwide dyslipidemia treatment guidelines.2,3 For 4 decades, the medical community has estimated LDL-C level by the Friedewald equation.4,5 The equation performs very well at a population level. However, as Dr Friedewald described,4 simply dividing triglyceride level by 5 does not give a very accurate estimate of very large-density lipoprotein cholesterol (VLDL-C)—the importance of inaccuracy depends on what fraction of the equation VLDL-C constitutes in the individual patient.